Project Overview: The major goals of this proposal are to develop and test a robotic device capable of providing targeted locomotor balance training for veterans with spinal cord injury (SCI). The working hypothesis is that this novel robotic tool will transform traditional body weight supported treadmill training (BWSTT) into a dynamic environment where balance-specific components of walking are measured and adaptively challenged, thereby enhancing locomotor training outcomes. Candidate: Dr. Gordon's objective is to establish a novel and productive, independent line of research within the VA system that will benefit the quality of life of veterans affected by SCI. Dr. Gordon has significant research experience in gait rehabilitation of SCI. He has observed that effective locomotor balance training and assessment tools are lacking within this field. For the purposed project, Dr. Gordon will develop a new robotic device capable of addressing this need. Combining Dr. Gordon's past experience with the training purposed in the current project will position Dr. Gordon at the forefront of this under-explored area of SCI gait rehabilitation. Research Development Plan: Dr. Gordon has assembled a diverse mentoring team, lead by Dr. Zev Rymer, to provide training and guidance in four critical project areas; rehabilitation robotics, neurophysiology of movement following SCI, locomotor balance and clinical care of SCI. Dr. Gordon will advance his formal knowledge of these areas through a combination of course work, directed readings and clinical shadowing. Dr. Gordon will also receive career development guidance in terms of establishing, funding and growing a productive independent research program through regular group mentoring sessions, active manuscript/grant writing and participation in grant writing and leadership seminars. Environment: The proposed research project will be conducted in VA designated space within the Sensory Motor Performance Program at the Rehabilitation Institute of Chicago (RIC), the top ranked rehabilitation hospital in the country. The resources provided by RIC include dedicated research space and equipment, clinical examination areas, offices space and machine shop. Clinical training and the primary recruitment of veterans with SCI will be performed through the Spinal Cord Injury Service at Edward Hines Jr. VA Hospital. Proposed Research: Aim 1) To create a library of robotic environments capable of providing challenging, balance-specific locomotor training. Applicant proposes to develop an intelligent robotic rehabilitation tool capable of A) applying a range of dynamic balance environments, including stabilizing and/or destabilizing lateral forces applied to the pelvis during gait, B) measuring locomotor stability in real-time and C) automatically adjusting the difficulty of the balance environments to optimally challenge the abilities of the participant. The device will consist of a moving coil forcer (linear motor) rigidly attached to the posterior of a pelvic harness. Software will control travel of the coil forcer along a track aligned perpendicular to the treadmill. Thus, movement of the coil forcer will exert a medial-lateral force on the user. He will develop software to create several balance-specific training environments that can be safely and easily delivered to people with SCI during treadmill walking. Aim 2) To test the effects of targeted locomotor balance training on gait stability, walking speed and energetic efficiency in incomplete SCI subjects. He will compare the effects of BWSTT performed in one of three balance-specific training environments. Ambulatory incomplete SCI subjects will receive BWSTT with either 1) a demanding dynamic balance environment that automatically and progressively adapts to continuously challenge the subject during gait; 2) no balance assistance (similar to unassisted walking on a treadmill); or 3) fixed balance assistance (similar to current approaches to BWSTT). He hypothesizes that the dynamic balance environment will result in the greatest improvements in walking speed, energetic gait efficiency and the ability to respond to gait perturbations. PUBLIC HEALTH RELEVANCE For people with spinal cord injury, balance deficits negatively impact three critical elements of walking; speed, stability and energetic cost. He hypothesizes that rehabilitation targeting walking balance has the potential to significantly enhance these three important factors and consequently improve mobility of veterans with chronic spinal cord injury. The major goal of this project is to develop and test an intelligent rehabilitation robotic tool capable of providing safe and challenging locomotor balance training. Ultimately, I aim to improve patient outcomes by producing an effective training device that can be easily incorporated into current gait rehabilitation programs. Results from this study will greatly advance the technology available to improve the balance component of walking as well as further our understanding of how balance deficits caused by spinal cord injury affect walking ability. Thus, the proposed project has the potential to substantially enhance the ability of the VA to deliver effective gait rehabilitation to veterans recovering from spinal cord injury.